Cheek LiftVoluma cheek fillerHead angle and lighting differ slightly between the photos.
Dermal fillers
Smile Line and Marionette Line Filler in Buckhead and Cumming
Smile line filler, usually hyaluronic acid, is injected under nasolabial folds, and sometimes marionette lines, to soften them. The FDA has approved several fillers for nasolabial folds, but its approval wording does not name marionette lines. Hyaluronic acid results are temporary, approximately 6 to 12 months according to the FDA, and a plan may treat the fold, the cheek above it, or both.
- 608 Google reviews, rated 4.9 and 5.0
- Board-certified physician who treats every patient herself
Treated by Dr. PaymanBuckhead and Cumming
What it treats
What are smile lines and marionette lines, and can filler treat them?
Yes, filler can soften both, with more evidence for smile lines. Smile lines, or nasolabial folds, run from the sides of the nose to the edges of the mouth, and the FDA lists them as an approved use for absorbable fillers. Marionette lines run from the corners of the mouth down toward the jaw, and the published evidence for filler there is smaller.
The FDA approval wording for hyaluronic acid (HA) fillers is correction of 'moderate to severe facial wrinkles and folds, such as nasolabial folds.' FDA records date this approval to December 2003 for Restylane, June 2006 for Juvederm and August 2017 for Revanesse Versa, which was approved as Revanesse Ultra. Fillers that are not HA are also approved for these folds, including Radiesse in 2006 and Sculptra Aesthetic in 2009.
None of the approval statements in the FDA's device database names marionette lines, so how a product's labeling applies to them is a question for your injector. One 12-month, open-label, single-center study of an HA filler in marionette lines, designed and funded by its maker, enrolled 83 adults. By an investigator's scale, 69.9% improved by at least 1 point at 1 month, 58.2% at 3 months and 51.3% at 6 months, according to the published study. It had no control group.
Results
How long do smile line fillers last?
Hyaluronic acid filler in smile lines is temporary, with effects the FDA puts at approximately 6 to 12 months. The patient labeling for one product, Juvederm Ultra Plus XC, says results last about 1 year. In an open-label marionette study, 53.8% of participants still rated their lines improved or much improved at 12 months, down from 96.4% at 1 month.
The evidence in detail
The marionette study showed a gradual decline from month 1 through month 12 rather than a sudden drop. The Juvederm labeling says correction is temporary and touch-up and repeat injections are usually needed to maintain it, and the FDA notes that the safety of repeated use over a long period has not been evaluated in a controlled clinical study. Your injector can tell you how often a refresh is realistic for your face.
Cheek LiftVoluma cheek fillerLighting differs slightly between the photos.
Cheeks, Chin, and LipsDermal fillerLighting and eye makeup differ between the photos.
Cheek FillerDermal fillerBackground, hair and lighting differ between the photos.
Cheek and Marionette FillerDermal fillerBackground and lighting differ between the photos.
Cheek and Marionette FillerDermal fillerBackground and lighting differ between the photos.
Dermal FillerBackground and lighting differ between the photos.
Drag the slider across each photo.Tap any photo to see it larger. These are Dr. Payman's own patients, shown with their written consent. These photos show individual results, not typical or guaranteed ones. Your result depends on your anatomy, the product, how much is used and how many visits you have. The number of visits and the time since treatment are not shown for most sets. See the full gallery.
Is it right for you?
Who is a good candidate for smile line filler, and who should wait?
Adults 22 and older whose folds bother them, who understand that results are temporary and want a softer fold rather than a flat one, are the usual candidates. Some people should wait or choose another route: the FDA says filler safety is unknown during pregnancy, while breastfeeding and under age 22, and injection should be delayed during active skin inflammation or infection.
The FDA also asks you to tell your provider about a bleeding disorder, severe allergies or a history of anaphylaxis, and allergy to lidocaine or to bacteria, since some fillers contain HA made by bacterial fermentation. It says safety is unknown in people prone to keloids or hypertrophic scars. The Juvederm Ultra Plus XC patient labeling adds caution for people on immunosuppressive therapy, says people who use aspirin or ibuprofen may bruise or bleed more at the injection site, says safety has not been studied in people with pigmentation disorders, and notes a possible risk of an inflammatory reaction if a laser or chemical peel follows treatment. Tell the office about any of these.
If you are unsure whether the fold or the cheek is the real issue, the consultation is where Dr. Payman can look at both. See cheek filler for the volume side of the question.
608
Google reviews across both officesWho treats you
Arshia Payman, MD
Board-certified physician with 13+ years in aesthetic medicine. Dr. Payman is the only provider at Derm Clinic MD, and she personally treats every patient. Every plan starts with a consultation, so it is made around your face and your goals.
- Medical schoolGeorge Washington University, Washington, D.C., where she also earned her undergraduate degree summa cum laude and was accepted to the early selection medical program in her sophomore year
- Hospital trainingFour hospitals in the Washington, D.C. area, including the National Institutes of Health and George Washington University Hospital
- ResidencyCompleted in 2008 at George Washington University
- Academic medicineOutpatient internal medicine at Emory University in Atlanta, as an instructor in clinical medicine who taught medical students
Georgia medical license 61513 (NPI registry).
Read Dr. Payman's full bioYour visit
What happens at a smile line filler visit?
Every treatment starts with an in-person consultation. Dr. Payman reviews your health history, allergies and medicines, looks at your folds and cheeks, and agrees a plan with you before any injection. The office will explain what to expect at your visit and afterward.
- Consultation and consentYou discuss goals, history, allergies and medicines, and you can review the patient labeling for the specific filler, as the FDA suggests.
- PlanYou and Dr. Payman choose the area (fold, marionette line, cheek or a mix) and the filler type, and the office tells you the cost before treatment.
- TreatmentYour injector will tell you how comfort is managed and what you will feel.
- AftercareFollow your written aftercare instructions. For one filler, the patient labeling lists avoiding strenuous exercise, extensive sun or heat exposure and alcohol for the first 24 hours, which is worth planning around in an Atlanta summer.
- Touch-upThe same labeling says a touch-up is usually given about 2 weeks to 1 month after the first injection, if needed.
Cost
How much does smile line filler cost?
Derm Clinic MD quotes your cost at the consultation, after Dr. Payman makes your plan, because the total depends on the areas treated and the filler used. For national scale, the American Society of Plastic Surgeons' 2023 statistics put the average physician fee at $715 for hyaluronic acid fillers and $901 for non-hyaluronic fillers such as Radiesse and Sculptra.
Those are national averages that vary by region and provider; ASPS says cost depends on the expertise of the person treating you, the type of procedure and the office location. They cover all filler procedures, not smile lines specifically. ASPS also notes that health insurance does not cover dermal fillers. See pricing and membership, where the Gold plan is $99 a month, saved toward dermal fillers, or book a consultation for a plan and quote.
Gold membership
$99 a month, saved toward Botox, Jeuveau or dermal fillers
- Jeuveau at $10 per unit, Botox at $11 per unit
- A vitamin B12 injection each month
- A chemical peel in your birthday month
- 10% off other services and skincare
Six-month minimum, then month to month. A $99 fee applies if you cancel before six months.
Compare
Which filler types are used for smile lines, and can each be dissolved?
Of the fillers Derm Clinic MD offers, three material types are approved for nasolabial folds: hyaluronic acid, calcium hydroxylapatite and poly-L-lactic acid. They differ in how long the FDA says they last and in whether an enzyme can reverse them, which matters most if this is your first filler. Dr. Payman will explain which fits your folds and why.
| Filler material | Examples | Effect lasts (FDA) | Can hyaluronidase dissolve it? |
|---|---|---|---|
| Hyaluronic acid | Juvederm, Restylane and Revanesse Versa families | Approximately 6 to 12 months | Yes (an off-label use) |
| Calcium hydroxylapatite | Radiesse | Approximately 18 months | No, per a 2024 review |
| Poly-L-lactic acid | Sculptra | May last up to 2 years; given in a series | No, per a 2024 review |
More on how they compare
The FDA says duration depends on the material and the area injected, and its approved fillers page gives the ranges above, so treat them as approximate. The 2024 JMIR Dermatology review lists poly-L-lactic acid and calcium hydroxylapatite among fillers hyaluronidase cannot dissolve. For how the options compare fold by fold, read our post on smile lines and your options, or see Sculptra and Radiesse.
Safety
What are the risks of smile line filler?
Common risks are bruising, redness, swelling, pain, tenderness and itching, and many pass within days to weeks. The most concerning risk is filler entering a blood vessel, which the FDA says has low odds but can cause tissue death, vision problems including blindness, or stroke. Get immediate medical attention for unusual pain, vision changes, or white, gray or blue skin near the injection site.
Full safety details
Less common problems the FDA lists include lumps or nodules that may need injections, antibiotics or surgery, infection, allergic reaction and, rarely, movement of the filler. Reactions can appear weeks, months or years later, and the FDA and the Juvederm labeling say inflammation near a filler site can develop after a viral or bacterial illness, a vaccination or dental work. In the marionette study, 13 of 83 participants reported a device-related event, most often pain, and none was serious. The Juvederm labeling also lists herpes among reported events, so mention cold sores to the office.
For nasolabial folds specifically, a 2025 American Academy of Ophthalmology review of 198 cases of vision loss after filler listed the nasolabial fold as the site in 9 of 226 injection sites, far fewer than the nose (90) or forehead (56). That describes where cases were reported, not proof that any area has no risk. If a vessel problem occurs with HA filler, hyaluronidase is the usual treatment, though the AAO review found treatments, including hyaluronidase, were usually not effective in reversing vision loss; see dissolving filler.
Patient reviews
In patients’ words
“She is very kind and pays attention to my requests for minimal treatment”
“I only trust this clinic with my Botox and fillers.”
“Once I met with Dr Arshia Paymen I never felt rushed, she took the time to listen to all my concerns and explained it all in a way that was easy to understand.”
Excerpts are quoted word for word from public Google reviews of Derm Clinic MD. Individual results vary.
Questions
Questions patients ask about smile line filler
Short answers here. Your own plan, product and cost are set with Dr. Payman at your consultation.
Ask at a consultationDo fillers work for marionette lines?
They can, but the evidence is limited. A 2025 open-label study of the filler VYC-17.5L (Cueto et al., Journal of Cosmetic Dermatology) was designed and funded by the filler's maker, and followed adults with a mean age of 59.2, mostly women with lighter skin types, so it may not predict your result. Ask your injector what to expect for your face and how long it is likely to last.
Is Restylane or Juvederm better for marionette lines?
The evidence for marionette lines tests one product at a time; it does not compare families. A 2025 open-label study in the Journal of Cosmetic Dermatology, for example, evaluated a single product (VYC-17.5L), and the FDA's filler pages do not compare products. Restylane, Juvederm and Revanesse Versa each include HA fillers with FDA approval for nasolabial folds, and the FDA reviewed each product for specific areas, so the choice depends on the product's labeling, the depth and area treated, and your injector's judgment.
Does Botox help smile lines or marionette lines?
Botox is not FDA-approved for nasolabial folds or marionette lines. The Botox Cosmetic label lists glabellar lines, lateral canthal lines, forehead lines and platysma bands, and says the safety and effectiveness of unapproved uses have not been established. See Botox for approved uses. The FDA's patient page also says the safety of using these fillers in combination with neuromodulators or other treatments has not been evaluated in a controlled clinical study.
Can smile line filler be dissolved if I don't like it?
If it is hyaluronic acid, hyaluronidase can break it down, a use that a 2024 review calls off-label in aesthetics. A 2024 JMIR Dermatology review lists poly-L-lactic acid and calcium hydroxylapatite fillers (Sculptra, Radiesse) among those hyaluronidase cannot dissolve. Results and the number of sessions vary. See dissolving filler for allergy risk and what to expect.
Does smile line filler hurt?
The Juvederm Ultra Plus XC patient labeling says some discomfort may occur during and after injection, that the gel contains an anesthetic to reduce injection-site pain, and that physicians may also numb the area with a cream. Tenderness is among the most common side effects it lists. Ask your injector how comfort is managed at your visit.
Is smile line filler the same as cheek filler?
No. They are separate approved uses. The FDA lists correction of wrinkles and folds such as nasolabial folds as one use for absorbable fillers and augmentation of the cheeks as another, and it approved products area by area. Some plans treat the fold, the cheek or both. See our cheek filler guide for the cheek side.
Two offices
Two offices. One physician.
Atlanta (Buckhead)
3833 Roswell Rd NE, Tuxedo Atrium, Suite 108Atlanta, GA 30342
Floor 1 of the Tuxedo Atrium
Monday to Friday 8:30 AM to 5 PM; Saturday 8:30 AM to 2:30 PM
Cumming
425 Peachtree Parkway, Suite 345Cumming, GA 30041
In The Shoppes at Brannon Crossing
Monday to Friday 8:30 AM to 5 PM; Saturday 8:30 AM to 2:30 PM
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Your first step
Ready to talk about smile line filler?
Book a consultation in Buckhead or Cumming and leave with a plan that fits your face, your goals and your budget.
Sources (14)
- Dermal Fillers (Soft Tissue Fillers). U.S. Food and Drug Administration, 2023. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers
- FDA-Approved Dermal Fillers. U.S. Food and Drug Administration, 2020. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/fda-approved-dermal-fillers
- Premarket Approval: Restylane Injectable Gel (P020023). U.S. Food and Drug Administration, PMA database, approved 2003. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P020023
- Premarket Approval: Juvederm 24HV, 30 and 30HV gel implants (P050047). U.S. Food and Drug Administration, PMA database, approved 2006. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P050047
- Premarket Approval: Revanesse Ultra, now Revanesse Versa (P160042). U.S. Food and Drug Administration, PMA database, approved 2017. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P160042
- Premarket Approval: Radiesse Injectable Implant (P050052). U.S. Food and Drug Administration, PMA database, approved 2006. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P050052
- Premarket Approval: Sculptra Aesthetic (P030050/S002). U.S. Food and Drug Administration, PMA database, approved 2009. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P030050S002
- Juvederm Ultra Plus XC Patient Labeling. AbbVie, FDA-approved labeling, 2023. https://www.rxabbvie.com/pdf/juvederm-ultra-plux-xc_pt_lb.pdf
- An Evaluation of VYC-17.5L for the Treatment of Marionette Lines: A Prospective, Open-Label, Postmarketing Study. Journal of Cosmetic Dermatology, 2025. https://pubmed.ncbi.nlm.nih.gov/39600229/
- Vision-Threatening Complications of Soft Tissue Fillers: A Report by the American Academy of Ophthalmology. Ophthalmology, 2025. https://pubmed.ncbi.nlm.nih.gov/40167411/
- Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations. JMIR Dermatology, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10836581/
- BOTOX Cosmetic (onabotulinumtoxinA): prescribing information, revised 10/2024. National Library of Medicine DailyMed, FDA-approved labeling, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=485d9b71-6881-42c5-a620-a4360c7192ab
- 2023 Average Surgeon/Physician Fees (archived copy). American Society of Plastic Surgeons, published 2024 (2023 data). https://web.archive.org/web/20240628010133/https://www.plasticsurgery.org/Documents/News/Statistics/2023/cosmetic-procedures-average-cost-2023.pdf
- Dermal Fillers Cost. American Society of Plastic Surgeons, accessed October 2026. https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/cost
This page is general education and is not medical advice. It does not replace an in-person consultation. Whether a treatment suits you, and what result is realistic, depends on your health history and an examination. Results vary from person to person.
Derm Clinic MD · Last updated October 2026.